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31.
32.
ARJ Mitchell MRCP NR Patel MRCP K Kamalvand MD MRCP A Topham VE Paul MD FRCS AN Sulke DM MRCP FACC 《International journal of clinical practice》2001,55(5):305-308
Electrophysiological studies (EPS) are now being performed in district general hospitals (DGH) in the UK. In order to audit our results, a prospective database was established for all patients undergoing EPS and radiofrequency (RF) ablation at Eastbourne District General Hospital, East Sussex. Between 1 January 1997 and 1 July 2000, 300 EPS procedures were performed, resulting in 155 RF ablations. The average RF ablation procedure time was 119.3 minutes with an average fluoroscopy time of 19.1 minutes. Cost per RF ablation procedure was £1166.79 excluding use of facilities, pacemaker devices, medical nursing and radiography staffing costs. The overall success rate for RF ablation was 93.6% with a major complication rate of 0.6%, a total complication rate of 3.9% and no associated mortality. We have shown that RF ablation can be performed safely, effectively and economically in a DGH setting with a high rate of success and a low complication rate. 相似文献
33.
Posterior Fossa Metastases: Risk of Leptomeningeal Disease When Treated with Stereotactic Radiosurgery Compared to Surgery 总被引:2,自引:0,他引:2
Siomin VE Vogelbaum MA Kanner AA Lee SY Suh JH Barnett GH 《Journal of neuro-oncology》2004,67(1-2):115-121
INTRODUCTION: Leptomeningeal disease (LMD) represents a diffuse form of central nervous system metastatic disease that is often associated with poor quality of life and prognosis. Our objective was to compare the incidence of LMD in patients with posterior fossa metastases (PFM) following stereotactic radiosurgery (SRS) versus surgical resection. METHODS: The medical records of 93 patients aged 57.9 +/- 10.8 years (mean +/- SD) with PFM treated at the Cleveland Clinic from 1995 to 2001 were analyzed retrospectively. Treatments consisted of surgery with whole brain radiation therapy (WBRT) or SRS with or without WBRT. The impact of age, Karnofsky performance status (KPS) at presentation, Radiation Therapy Oncology Group, recursive partitioning analysis (RPA) class, status of extracranial disease, number, size, volume, pathology of brain metastases and steroid use were studied using univariate and multivariate analyses. RESULTS: There were 80 evaluable patients (10 lost to follow-up and three excluded for supratentorial surgery with subsequent LMD). LMD occurred after the surgical removal of the PFM in 9 of 18 patients (50%), whereas LMD occurred after SRS in 4 of 62 patients (6.5%) (p = 0.0028). Multivariate analysis also showed that patients who had surgery were more likely to develop LMD compared to patients treated with SRS (p = 0.0024). Patients had a median KPS decline of 30 points after LMD was diagnosed. There was no statistically significant difference in survival of patients with LMD and the rest of the patients (13.5 vs. 11.7 months, p = 0.7659). Patients treated surgically had significantly larger lesions (3.43 +/- 0.74 vs. 1.96 +/- 0.95 cm maximum diameter, p < 0.0001). All surgical patients belonged to RPA class II at diagnosis. Their survival was not different from the RPA class II patients in the SRS group. Surgery and SRS had comparable complication rates (8.1% vs. 5.6%, p = 0.99), although the surgical complications were more serious (e.g. hemorrhage, CSF leak). The duration of steroid use was longer after SRS compared to surgery (2.1 +/- 3.6 vs. 1.3 +/- 2.4 months); however, the difference was not statistically significant. Myopathy and psychosis in one patient after SRS, were the only steroid-related complications. There was no statistically significant association between the primary tumor type and the presence of LMD. CONCLUSIONS: In this retrospective analysis of patients with PFM, SRS was associated with a lower incidence of LMD than was surgery. Although LMD was associated with rapid and considerable decline in the quality of life, it did not influence the overall survival. SRS was associated with less serious complications than surgery. Surgery in this study was performed on patients with larger lesion sizes and a trend toward poorer initial performance status, which could bias these results. A prospective study directly comparing surgery and SRS and further evaluating the significance of LMD in PFM is warranted. 相似文献
34.
Lubet RA; Steele VE; DeCoster R; Bowden C; You M; Juliana MM; Eto I; Kelloff GJ; Grubbs CJ 《Carcinogenesis》1998,19(8):1345-1351
The chemopreventive activity of the highly specific nonsteroidal aromatase
inhibitor, vorozole, was examined in the methylnitrosourea (MNU)-induced
rat model of mammary carcinogenesis. Various doses of vorozole (0.08-1.25
mg/kg body wt/day) were administered daily (by gavage) to female
Sprague-Dawley rats starting at 43 days of age. Seven days later, the rats
were given a single i.v. dose of MNU (50 mg/kg body wt). Rats were
continually treated with vorozole until the end of the experiment (120 days
post-MNU). Vorozole caused a dose dependent inhibition of mammary cancer
multiplicity. The highest dose of vorozole (1.25 mg/kg body wt/day)
decreased cancer multiplicity by approximately 90%, and simultaneously
decreased cancer incidence from 100 to 44%. The next two highest doses of
vorozole (0.63 and 0.31 mg/kg body wt/day) inhibited MNU-induced mammary
cancer multiplicity by 70-80%. Even the two lowest doses of vorozole (0.16
and 0.08 mg/kg body wt/ day) decreased cancer multiplicity -50%. Serum
level determinations were performed on a variety of endpoints at either 4
or 24 h following the last dose of vorozole. Insulin-like growth factor
(IGF)-1 levels were slightly, but significantly, increased by vorozole
treatment. Vorozole induced striking increases in serum testosterone levels
at 4 h at all the dose levels employed. Testosterone levels were
significantly elevated over controls at 24 h in rats given the lower doses
of vorozole (0.08-0.31 mg/kg body wt/day), but were significantly lower
than in rats administered the higher doses of vorozole (0.63 or 1.25 mg/kg
body wt/ day). This result presumably reflects the limited half- life of
vorozole in rats. In a second series of experiments, the effects of limited
duration of dosing with vorozole (2.5 mg/kg body wt/day) or intermittent
dosing with vorozole were determined. Treatment of rats with vorozole for
limited time periods, from 3 days post-MNU administration until 30 or 60
days post-MNU treatment, resulted in significant delays in the time to
appearance of palpable cancers. However, these limited treatments did not
greatly affect the overall incidence or multiplicity of mammary cancers
when compared with the MNU controls at the end of the study (150 days
post-MNU). Finally, the effects of intermittent dosing with vorozole (2.5
mg/kg body wt/day) were examined. Rats were administered cycles of vorozole
daily for a period of 3 weeks followed by treatment with the vorozole
vehicle for the next 3 weeks (total of four cycles). Although this
intermittent treatment did inhibit the appearance of new tumors during each
of the periods that vorozole was administered, it did not cause regression
of palpable cancers.
相似文献
35.
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37.
VE Ghantous TD Eisen AH Sherman FO Finkelstein 《American journal of kidney diseases》1999,33(1):36-42
The incidence and prevalence of end-stage renal disease (ESRD) continues to increase, especially in the elderly population. The role of renovascular disease in contributing to ESRD is still not well defined. The objective of this study was to determine the utility of gadolinium (Gd)-enhanced magnetic resonance angiography (MRA) in evaluating elderly patients with renal insufficiency for renal artery stenosis (RAS). A 7-month prospective study conducted in a tertiary referral center evaluated 40 consecutive patients with progressive renal insufficiency (18 men and 22 women; mean age, 70 +/- 5.6 [standard deviation] years) and high clinical suspicion for renovascular disease with Gd-enhanced MRA. Digital subtraction angiography (DSA) was obtained in only those patients with significant RAS detected by MRA. Twelve patients had significant RAS. Six of these patients had percutaneous transluminal renal angioplasty (PTRA), five patients had renal artery bypass surgery, and one patient had a stent placed after PTRA. Seventy-eight renal arteries were satisfactorily evaluated by MRA. Twenty-two renal arteries were evaluated by both MRA and DSA. Of the 12 significant stenoses detected by the MRA, 11 were confirmed by DSA and 1 was confirmed at the time of surgical revascularization. It is concluded that Gd-enhanced MRA is a useful test for the evaluation of RAS in patients with compromised renal function. 相似文献
38.
Thompson HJ; McGinley JN; Wolfe P; Singh M; Steele VE; Kelloff GJ 《Carcinogenesis》1998,19(12):2181-2185
An experimental model for mammary carcinogenesis has been described in
which intraductal proliferations, ductal carcinomas in situ and
adenocarcinomas can be readily detected and the frequency of their
occurrence quantified. The objective of the experiment reported in this
study was to determine the latency period between carcinogen administration
and the occurrence of each of these types of lesion. A total of 150 female
Sprague-Dawley rats were injected i.p. with 50 mg 1- methyl-1-nitrosourea
(MNU)/kg body wt at 21 days of age. Groups of 30 rats each were killed at
7, 14, 21, 28 and 35 days post-carcinogen. Mammary intraductal
proliferations were the first detected lesions and were observed in 20% of
the animals at 14 days following carcinogen administration. At 21 days
post-carcinogen ductal carcinomas in situ and adenocarcinomas were
observed. The number of each type of lesion increased with time
post-carcinogen, but the temporal pattern of occurrence was different among
lesion types. The pattern of lesion occurrence was consistent with
intraductal proliferations being a precursor lesion for ductal carcinomas
in situ and adenocarcinomas. Furthermore, the data imply that ductal
carcinomas in situ represent one pathway of morphological progression by
which intraductal proliferations evolve into invasive carcinomas, but that
this lesion type, as currently defined histologically, may not be an
obligatory intermediate in morphologic progression. These findings are
consistent with emerging evidence of multiple but distinct pathogenetic
pathways leading to mammary carcinomas that display different morphological
patterns and biological activities.
相似文献
39.
40.
Kanner AA Suh JH Siomin VE Lee SY Barnett GH Vogelbaum MA 《Stereotactic and functional neurosurgery》2003,81(1-4):18-23
BACKGROUND: Brain metastases are a leading cause of mortality and morbidity in patients with malignancies. Infratentorial location has been considered a negative prognostic factor. METHODS: This retrospective study evaluated patients with cerebellar metastasis. Statistical analysis assessed age, extracranial disease, performance status and treatment. Patients were categorized by Radiation Therapy Oncology Group recursive partitioning analysis (RPA). Treatment included surgery, stereotactic radiosurgery (SRS) and whole brain radiotherapy (WBRT) alone or in combination. RESULTS: Of 93 patients, the median survival was 12.9 months for RPA class I, 11 months for class II and 8 months for class III. On multivariate analysis, RPA class was an important predictor for overall survival. However, SRS with WBRT or surgery with WBRT or a combination of SRS, surgery and WBRT, was more favorable than surgery or SRS alone within RPA class II patients. CONCLUSIONS: Survival of patients with cerebellar brain metastasis is comparable to that of patients with supratentorial brain metastasis using RPA classification. Aggressive multimodality therapy has a favorable impact on survival. 相似文献